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Acute Care for Traumatic Injuries and Surgical Outcomes
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Acute Care for Traumatic Injuries and Surgical Outcomes

A special issue of Journal of Clinical Medicine (ISSN 2077-0383). This special issue belongs to the section "Emergency Medicine".

Deadline for manuscript submissions: 31 March 2025 | Viewed by 5638

Special Issue Editors

Dr. Matthias Fröhlich

E-Mail Website
Guest Editor
Department of Traumatology, Orthopaedic Surgery and Sports Traumatology, Cologne-Merheim Medical Centre (CMMC), Witten/Herdecke University, 51109 Cologne, Germany
Interests: orthopedics; trauma surgery; sports traumatology; polytrauma care; hip and knee; preclinical trauma care
Dr. Michael Caspers

E-Mail Website
Guest Editor
1. Department of Traumatology, Orthopaedic Surgery and Sports Traumatology, Cologne-Merheim Medical Centre (CMMC), Witten/Herdecke University, 51109 Cologne, Germany
2. Institute for Research in Operative Medicine (IFOM), Cologne Merheim Medical Center (CMMC), University of Witten/Herdecke, Ostmerheimer Str., 200, 51109 Cologne, Germany
Interests: trauma surgery; polytrauma care; coagulation

Special Issue Information

Dear Colleagues,

This Special Issue focuses on the immediate management and treatment of traumatic injuries, as well as the subsequent surgical outcomes, resulting from accidents, falls, violence, or other forms of physical trauma. The field of acute care for traumatic injuries involves providing timely and specialized medical interventions to stabilize patients, prevent further damage, and optimize outcomes, which may include emergency resuscitation, diagnostic imaging, surgical interventions, pain management, and rehabilitation. Since the average life expectancy of global populations has been increasing in recent decades, doctors now often have to provide care for patients who suffer from several comorbidities, which may require specialized treatment algorithms for older patients.

By continually improving acute care protocols and surgical techniques, healthcare professionals aim to enhance patient outcomes, minimize complications, and improve the overall quality of life of individuals who have experienced traumatic injuries. With this purpose in mind, we cordially invite all authors to submit original or review articles to the Special Issue.

Dr. Matthias Fröhlich
Dr. Michael Caspers
Guest Editors

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Journal of Clinical Medicine is an international peer-reviewed open access semimonthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2600 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

  • trauma injuries
  • orthopedics
  • polytrauma
  • emergency care
  • coagulation disorders
  • fractures
  • surgical outcomes
  • acute care
  • diagnostic imaging

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Published Papers (4 papers)

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Research

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8 pages, 502 KiB  
Article
Epidemiology and Mortality of Surgical Amputations in Severely Injured Patients with Extremity Injuries—A Retrospective Analysis of 32,572 Patients from the TraumaRegister DGU®
by Julian Scherer, Jakob Hax, Michel Paul Johan Teuben, Hans-Christoph Pape, Rolf Lefering and Kai Sprengel
J. Clin. Med. 2024, 13(22), 7000; https://doi.org/10.3390/jcm13227000 - 20 Nov 2024
Viewed by 204
Abstract
Background: Extremity fractures are common injuries in polytraumatized patients. Concomitant injuries to the soft tissue, vessels and nerves in these fractures are defined as mangled extremities. The decision for or against limb salvage is dependent on the patient’s physiology and the limb status. [...] Read more.
Background: Extremity fractures are common injuries in polytraumatized patients. Concomitant injuries to the soft tissue, vessels and nerves in these fractures are defined as mangled extremities. The decision for or against limb salvage is dependent on the patient’s physiology and the limb status. In severely injured patients with critical physiological status, limb salvage may be contraindicated. International data on the epidemiology and management of mangled limbs in severely injured patients are lacking. Thus, the aim of this study was to assess the incidence of polytraumatized patients with severe injuries to either upper (UL) or lower limb (LL) as well as their management. Methods: A retrospective cohort analysis was conducted of patients aged 16 years and above with an Injury Severity Score (ISS) ≥ 16 who sustained fractures to the limbs and were admitted to a certified trauma center of the TraumaRegister DGU® (TR-DGU) between 2009 and 2019. Results: In total, we assessed 32,572 patients (UL: 14,567, mean age 48.3 years, 70% male and LL: 18,005, mean age 47.0 years, 70.5% male) The mean ISS in UL was 28.8 (LL 29.3). Fractures to the humerus (n = 4969) and radius (n = 7008) were predominantly assessed in UL, and fractures to the femur (n = 9502) and tibia (n = 8076) were most common in LL. In both groups, the most frequent injury mechanism was motor vehicle accidents, and more than half (UL: 9416 and LL: 11,689) of the patients had additional severe Abbreviated Injury Scale (AIS) ≥ 3 chest trauma. 915 patients in UL and 1481 in LL died within 24 h of the index admission. Surgical amputation occurred in 242 (UL) and 422 (LL) cases with a peak ratio in patients with an ISS above 50 in both groups. In both groups, patients with severe concomitant chest trauma were more often surgically amputated. In both groups, fewer patients with surgical amputations died within 24 h of admission (3.3% vs. 6.3% UL; 6.4% vs. 8.3% LL) compared to patients without amputation, but more patients with surgical amputations died within the overall hospital admissions (15.7% vs. 11.9% UL; 19.2% vs. 14.2%). In both groups, hemodynamical shock as well as the administration of Packed Red Blood Cells (PRBCs) were associated with a higher amputation rate. Conclusions: Surgical amputations after major trauma seem to be rare. Hemodynamical instability seems to play a key role in the management of mangled limbs. Patients with life-saving surgical amputation still have an increased overall in-hospital mortality. Full article
(This article belongs to the Special Issue Acute Care for Traumatic Injuries and Surgical Outcomes)
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9 pages, 414 KiB  
Article
The Efficacy of Intraosseous Access for Initial Resuscitation in Patients with Severe Trauma: A Retrospective Multicenter Study in South Korea
by Youngmin Kim, Seung Hwan Lee, Sung Wook Chang, Yo Huh, Sunju Kim, Jeong Woo Choi, Hang Joo Cho and Gil Jae Lee
J. Clin. Med. 2024, 13(13), 3702; https://doi.org/10.3390/jcm13133702 - 25 Jun 2024
Viewed by 1303
Abstract
Background/Objective: In patients with severe trauma, intraosseous (IO) access is an alternative when intravenous (IV) access proves challenging. However, detailed insights into its utilization patterns and effectiveness are lacking. This study aims to evaluate the use and efficacy of IO access in hemodynamically [...] Read more.
Background/Objective: In patients with severe trauma, intraosseous (IO) access is an alternative when intravenous (IV) access proves challenging. However, detailed insights into its utilization patterns and effectiveness are lacking. This study aims to evaluate the use and efficacy of IO access in hemodynamically unstable patients with trauma at level-1 trauma centers in South Korea. Methods: Data from six centers over 12 months were analyzed, focusing on patients with traumatic cardiac arrest or shock. Overall, 206 patients were included in the study: 94 in the IO group and 112 in the IV group. Results: The first-attempt success rate was higher in the IO group than in the IV group (90.4% vs. 75.5%). The procedure time in the IO group was also shorter than that in the IV group. The fluid infusion rate was lower in the IO group than in the IV group; however, the use of a pressure bag with IO access significantly increased the rate, making it comparable to the IV infusion rate. Further, regarding IO access, a humeral site provided a higher infusion rate than a tibial site. Conclusions: IO access offers a viable alternative to IV access for the initial resuscitation in patients with trauma, providing advantages in terms of procedure time and first-attempt success rate. The use of a pressure bag and a humeral site for IO access afforded infusion rates comparable to those associated with IV access. Full article
(This article belongs to the Special Issue Acute Care for Traumatic Injuries and Surgical Outcomes)
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Review

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9 pages, 795 KiB  
Review
Heterotopic Ossifications Following Intramedullary Stabilization of Femoral Fractures in Polytraumatized Patients
by Gregor Wollner, Florian Hruska, Felix R. M. Koenig, Thomas Haider and Lukas L. Negrin
J. Clin. Med. 2024, 13(18), 5557; https://doi.org/10.3390/jcm13185557 - 19 Sep 2024
Viewed by 616
Abstract
Introduction: Heterotopic ossifications (HOs) are a well-known complication following total hip arthroplasty. Yet only little is known about the development of HOs following a femoral fracture and intramedullary stabilization in polytraumatized patients. Thus, the present study aimed to investigate whether the development of [...] Read more.
Introduction: Heterotopic ossifications (HOs) are a well-known complication following total hip arthroplasty. Yet only little is known about the development of HOs following a femoral fracture and intramedullary stabilization in polytraumatized patients. Thus, the present study aimed to investigate whether the development of HOs is being observed more frequently in patients suffering polytrauma compared to those with single-extremity trauma. Materials and Methods: The retrospective outcome study was conducted at our level I trauma center. All patients admitted from 2010 to 2020 were included if they (1) presented with multiple injuries (≥2 body regions), (2) had an Injury Severity Score ≥16, (3) suffered a femoral fracture, and (4) were treated with intramedullary stabilization. Furthermore, a control group was established to match the polytrauma group (sex, age), who were suffering from single-extremity trauma (femoral fracture) which was treated with intramedullary stabilization. Subsequently, X-rays of the hip were performed and evaluated for up to one-year post-trauma. Results: Our study group consisted of 36 patients in total (91.7% male; mean age 39.4 ± 17.4 years, range: 18–82 years). The polytrauma (PT) group included 12 patients (mean age 39.5 years, median ISS 28), whereas the control group (single-extremity-trauma) included 24 patients (mean age 39.3 years). We documented HOs in nine (75%) patients in the PT group vs. five (20.8%) patients in the single-extremity group (p = 0.03). Conclusion: In this study, we were able to demonstrate that heterotopic ossifications are being observed significantly more frequently in patients suffering from polytrauma in comparison to patients with single-extremity trauma following intramedullary stabilization after a femoral fracture. Full article
(This article belongs to the Special Issue Acute Care for Traumatic Injuries and Surgical Outcomes)
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Other

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14 pages, 1671 KiB  
Case Report
Positive Outcomes Following Cervical Acceleration-Deceleration (CAD) Injury Using Chiropractic BioPhysics® Methods: A Pre-Auto Injury and Post-Auto Injury Case Series
by Tim C. Norton, Paul A. Oakley, Jason W. Haas and Deed E. Harrison
J. Clin. Med. 2023, 12(19), 6414; https://doi.org/10.3390/jcm12196414 - 9 Oct 2023
Cited by 3 | Viewed by 3208
Abstract
This series illustrates how rear-end impact motor vehicle collisions (MVCs) alter the cervical spine’s alignment and demonstrates therapeutic use of cervical extension traction to improve lordotic alignment and other outcomes. This is a retrospective reporting of 7 adult patients (4 males and 3 [...] Read more.
This series illustrates how rear-end impact motor vehicle collisions (MVCs) alter the cervical spine’s alignment and demonstrates therapeutic use of cervical extension traction to improve lordotic alignment and other outcomes. This is a retrospective reporting of 7 adult patients (4 males and 3 females, 28–42 years) treated for cervical hypolordosis. These subjects received Chiropractic BioPhysics® (CBP®) rehabilitation and then were involved in a rear-end MVC. All cases had radiographic assessment that quantified the buckling of the cervical spine, presumably resulting directly from the CAD trauma. After an average of 3 years and 9 months (range: 1–7.6 years) following their initial program of care, the 7 patients sought care for a second time after the MVC. At this time, compared with their previously recorded post-treatment spine radiographs, there was an average 18.7° (range: 7.6–35.4°) reduction in cervical lordosis, a 9.2 mm (range: 3.6–19.8 mm) increase in anterior head translation (AHT), an 11.3° (range: 0.2–19.9°) decrease in the atlas plane line (APL), as well as a 35.7% (range: 22–52%) average neck disability index score (NDI) measured after the MVC. After the crash, a second round of CBP rehabilitation was administered, resulting in an average 15.1° improvement in cervical lordosis, 10.9 mm reduction in AHT, 10.4° increase in APL, and a 23.7% drop in NDI after an average of 35 treatments over 9 weeks. Treatment was universally successful, as an average 80% re-establishment of the lordosis toward its pre-injury state was found. There were no adverse events reported. This case series demonstrates that motor vehicle collisions may alter the alignment of the cervical spine. Rehabilitation of the cervical curve using extension traction improved the patients’ initial pre-crash alignments toward their pre-injury alignments and was likely responsible for improvement in the patients’ conditions. Clinical trials are needed to confirm these findings. Full article
(This article belongs to the Special Issue Acute Care for Traumatic Injuries and Surgical Outcomes)
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